Stereotactic robot-assisted MRI-guided laser interstitial thermal therapy thalamotomy

Stereotactic Robot-assisted Magnetic resonance image-guided laser interstitial thermal therapy thalamotomy is a minimally invasive surgical technique used to treat certain neurological conditions, such as essential tremor, Parkinson's disease, and chronic pain. The procedure involves using a laser probe, guided by real-time MRI imaging, to deliver focused heat energy to the specific area of the brain that is causing the patient's symptoms. The goal of the treatment is to create a lesion in the targeted area of the brain, which disrupts the abnormal neural activity causing the symptoms. The use of a stereotactic robot allows for precise targeting of the treatment area and improves the accuracy and safety of the procedure.

2 patients with medically intractable PD tremors were treated with stereotactic robot-assisted MRIg-LITT thalamotomy performed under general anesthesia with intraoperative electrophysiological testing. Pre and postoperative tremor scores were assessed using the Fahn-Tolosa-Marin tremor rating scale (TRS).

At 3-month follow-up, both patients demonstrated significant improvement in tremor symptoms subjectively and according to the TRS (75% for both). Patients also had substantial improvements in their QOL (32.54% and 38%) according to the 39-item PD questionnaire. Both patients underwent uncomplicated MRIg-LITT thalamotomy.

In patients with medically intractable PD tremors who are unsuitable candidates for DBS, thalamotomy utilizing a stereotactic robot, intraoperative electrophysiological testing, and laser ablation with real-time MRI guidance may be a viable treatment option. However, further studies with larger sample sizes and longer follow-up periods are necessary to confirm these preliminary results ¹⁾